‘where they live’
Clinica Sierra Vista’s street team vaccinates homeless
The sun had only been up for a few minutes Thursday when members of Clinica Sierra Vista’s street medicine team began gathering outside the organization’s clinic in east Bakersfield.
A half-hour later they found themselves hiking a dirt trail parallel to the
Kern River near the center of the city. They were headed to a place they’d been to many times before, a place where people live mostly unsheltered, not only from the wind and the heat and the cold, but also from all sorts of potential harm, including COVID-19.
“Morning, guys. Street medicine!”
Dr. Matthew Beare, Clinica’s director of special populations, always calls out a polite hello as he approaches a group of makeshift tents. On this morning, he was greeted by campfire smoke drifting on the wind, five yapping Chihuahuas, a pit bulldog named Lilly, and five adults who live in the encampment.
Beare, who has been dedicated to street medicine for years, is on a mission this spring to provide vaccinations to as many people he can find who are willing to roll up their sleeves.
He wanted to vaccinate all five at the camp — although he had his doubts he could convince everyone.
“We have the Johnson & Johnson vaccine, which is good for this situation,” said Clinica Sierra Vista spokesman Tim Calahan. “It’s one and done.”
Many homeless individuals do not have a phone, Calahan explained. So getting them fully vaccinated in one shot is ideal.
For the street medicine team, bringing gifts of food, first aid
kits, hats and socks helps build rapport. But watch Dr. Beare, and it soon becomes clear that the difference is his easy manner, and his willingness to let each individual he meets make the decision about how much or how little medical care he or she is going to accept.
Street medicine is designed to deliver primary and urgent care to people “where they live,” Beare said. When the patients can’t come to you, you go to them, un
der bridges, along rivers, in shelters, soup kitchens, on city streets, in parks.
By the time he and his team walked away from the encampment Thursday, all five of the adults had been vaccinated.
And that success continued later in the morning at Riverview Park in Oildale.
As case worker Maribel Bautista kept track of every medical contact, and helped set up appointments — and even schedule transportation to clinics — the outreach extended well beyond these initial points of contact.
Vaccinations are important but never were the end-all for the team. At one point, Beare was using a stethoscope to examine one of the residents, Mary Sawyer, who complained of symptoms that had the physician asking lots of questions.
But even more goes on during these weekly visits, more than medical services.
“Today, we have a psychiatrist with us, we have Behavioral Health Services, we have case management and outreach,” Beare said. “Vaccine aside, our approach to street medicine has always been multi-disciplinary.
“Health care needs don’t stop at disease,” he said. “A lot of what we’re treating are social determinants of health and access to care.”
Maybe he’s being generous, but Beare insists that the medical care he and his team provide pales in importance to those other efforts that are going on simultaneously to help his patients make changes.
“It’s the housing, it’s the harm reduction that really makes the difference,” he said.
Harm reduction includes preventing hepatitis C, preventing infections, getting a homeless person in to see a dentist, or convincing a vulnerable person to get vaccinated.
Just being present may be the biggest form of harm reduction.
Melita Dean, 53, said yes to the vaccine Thursday. Beare had already created an atmosphere of
trust, she said, and a feeling that she is being treated like an adult human, and nothing less.
“He’s my primary care doctor,” Dean said of Beare. “He’s great. I couldn’t have gotten a better doctor.”
Watching Beare’s approach, the way he forms relationships with patients who have no reason to trust him, it soon becomes apparent that his empathy is close to the surface.
But he’s not satisfied with what he and his team have accomplished.
There are only two street medicine teams in all of Kern County, he said.
And they are not reaching many who continue to be in need.
“Why can’t we have 10 to 15 street medicine teams?” he asked.
It’s a question without an answer.